There are so many jokes about mammograms! Have you heard the one about the fridge door … or the bookends … or the garage floor? Thanks to all the jokes, “Mammogram” has become a household word, and it’s not that I don’t have a sense of humor, but as a mammography technologist, I’ve heard the jokes many times. I think the jokes are embarrassing for women and demeaning with regard to their physical bodies. Many women say, “If men had to do this, there would be a better solution” – this may or may not be true. Most people agree that mammograms are not perfect, but until there is a better solution, I think it’s time to look at mammograms in a different light.
In May of 1985 and 1986 I asked my doctor to order a mammogram for me and he refused both times saying I was too young. There were no screening mammography centers to which I could refer myself, so that was that. In December of 1986 at the age of 42 I felt a lump in my breast and had a mammogram the same day. It turned out to be Stage II breast cancer with 4 positive lymph nodes. I had a lumpectomy, a mastectomy and chemotherapy but chose not to have radiation. I obviously wasn’t too young to have cancer.
In May 1985 a mammogram cost less than $60.00 and would have resulted in my having minor surgery to deal with a small lump. Delaying the diagnosis until December 1986 raised the cost of the medical care I received both in dollars and the amount of human suffering we faced. I say “we” because a diagnosis of cancer affects the family, friends and community of the person with the disease. A timely mammogram would have saved us all a lot of grief.
The common perception is that having a mammogram is a negative experience; I think this is a bad rap. Mammograms are quick and easy breast X-Rays; which usually means two views of each breast – one from the top and one from the side. They are performed by friendly, knowledgeable technologists who do their best to help women feel at ease. The technologists’ goal is to get the best films possible and also to make the experience as quick and painless as possible.
When people go for a mammogram the most important thing to know is that relaxation of the upper body is the key to a positive experience. I know it’s hard to relax when you’re apprehensive, but this is why I believe we need to lessen the public apprehension of this test. It is easy to relax by taking some deep breaths before you have the test. By relaxing your muscles you will be much more comfortable through the test than if you are tense. An added bonus is that the films will be of higher quality, as it is easier to image the back of the breast close to the chest wall if the pectoralis muscles are relaxed. When it’s done, you may hear yourself saying, “That wasn’t bad at all!”
Some women are embarrassed to have a mammogram because they don’t want anyone other than their partner to see and touch their breasts. The mammogram jokes add to their fear of pain and embarrassment making it harder for them to manage, and I know of some women who avoid having a mammogram for this reason. The test is done in privacy; no one but a female technologist will be present. Technologists, for the most part, are sensitive people who will do the test as quickly and professionally as they can. Many women who have resisted the test for a long time are amazed at how simple and painless it can be.
Mammograms include compression of the breast with a plastic plate to produce a high quality image with the least amount of radiation. Breast compression is meant to be tight, but it should not be painful and it only lasts for a few seconds. If you think about looking at a bunch of grapes – it’s hard to see them all from one spot. If you spread the grapes out, you can see more grapes. Similarly with the use of compression, more breast tissue is visible when the breast is spread out. With a flatter, thinner layer of tissue the amount of radiation required is less than if the breast is not compressed. The amount of radiation you get is as low as can be achieved if adequate compression is used, and also if good quality control is maintained at the mammogram facility.
In most places in Canada, women can book their own appointment for a free screening mammogram; a doctor’s referral is not required. In places without a screening program, mammography is available with a doctor’s referral and is covered by health insurance. Approximately 7% of women will be asked to have further testing. Most of the time, follow up testing involves an additional mammogram with a different view to separate the breast tissue in a particular area to get a better image. In my analogy of the bunch of grapes, it’s like having a few grapes on top of each other and separating them out in a different way in order to see them better.
There is controversy about the age bracket for women to have a mammogram. On a mammogram film, normal breast tissue in young women usually appears to be dense; normal breast tissue in older women usually turns to fat and appears less dense. Reading mammograms on young women is like looking through a tree which is full of leaves in summer. Reading mammograms on older women can be compared to looking through a tree in winter. You can see why reading mammograms on young women is more complex than reading films on older women and this is the main reason why screening mammography is more effective as women mature.
The fear of being diagnosed with breast cancer will often prevent a woman from having a mammogram. My personal experience is that it is much better to be diagnosed earlier rather than when the cancer has had chance to spread. The amount of fear, pain, embarrassment, and emotional anguish from having a mammogram does not even come close to that of being diagnosed with an advanced cancer. A mammogram takes about 10 minutes; an early cancer can be dealt with in a reasonable amount of time, while an advanced cancer is much more of a time commitment. The amount of fear that comes with a cancer diagnosis is astronomical compared to that of a screening mammogram.
It is often recommended that women have a screening mammogram every two years, but many people believe it is better to have mammograms on an annual basis. It is probably best if women can consult their doctors and make the decision on an individual basis. A number of factors affect the decision such as age, family history, general health, and previous breast problems. Between appointments, whether you choose to have a mammogram every year or every two years, it is important to be aware of any breast problems. If you notice anything unusual it is wise to contact your doctor. This applies even if your mammogram was negative because there are a certain percentage of cancers that do not show on a mammogram.
The Canadian Breast Cancer Foundation promotes a three-prong approach to breast health:
- annual clinical breast exam by a doctor or trained health professional
- screening mammogram
- monthly breast self exam
Breast self-exam can be a controversial issue. Many people do not recommend monthly self-exams, yet many women have found their own breast cancers this way. The important thing to remember is if you choose to do self exam, to do it right:
- learn the proper method from a doctor or trained health professional
- be disciplined and practice it regularly
- pick the same time of your menstrual cycle or the same date each month
- get to know your normal breast “architecture”
- make notes of your findings, draw pictures and record dates
- make detailed notes of unusual findings including dates
- check with your doctor if you find anything worrisome
Following these steps will give you confidence and put you in charge of your breast health. Some health professionals are concerned that women will be unnecessarily alarmed if they find a problem with their breasts. I believe that an educated approach to breast care will reduce the fear that many women live with, and they can consult their doctors in a more rational manner. Most breast lumps are benign, but early detection of breast cancer is worth the extra cost of investigating lumps and other unusual findings.
Mammography is a peculiar test in some ways. However, it is the gold standard at present and until there is a better method of screening which is also cost effective it makes good sense to have regular mammograms. Finding cancer in the early stages before it has a chance to spread makes the treatment much easier and the cure rate much higher. Having a mammogram is not meant to be funny, or even fun; but a few minutes of discomfort rewards us with knowing we are taking action to help protect our breast health.